Effects Of C-Mill Gait Adaptability Training On Lower Limb Motor Function In Stroke Patients

Objective:This study designed a novel gait adaptability training program for stroke patients,aiming at:(1)Through 4 weeks of C-Mill gait adaptability training,the effectiveness of gait parameters,clinical walking function,balance function and self-efficacy in stroke patients was investigated.(2)To further explore the biomechanical mechanism of C-Mill gait adaptability training on the rehabilitation of lower limb motor function in stroke patients,and to provide scientific quantitative basis for the improvement of clinical function.Method:This study screened 22 patients with lower extremity motor dysfunction after stroke in the Rehabilitation Department of Huadong Hospital from 2018.11 to 2019.11,they were randomly divided into gait adaptability training group(GAT group)and routine walking training group(control group),with 11 cases in each group.The GAT group adopted the C-mill intelligent gait training instrument to conduct adaptive walking training for patients with augmented reality technology,including target matching,obstacle avoidance and scenario simulation.The control group used conventional walking training,including walking decomposition exercises,weight training on the affected lower limb,and swing training on the healthy side.Each group was trained for four weeks,five times a week,once a day for about 35 minutes.Subjects underwent functional assessments at baseline and at the end of 4 weeks of training,including the Berg balance scale,the Functional Ambulation Category Scale,The Activities-specific Balance Confidence Scale,and the Three-dimensional gait analysis.In the control group,1 subject dropped out,and the remaining 21 subjects completed the study.SPSS 22.0 statistical software was used for data processing.Two-factor repeated measurement analysis of variance was used to define the(two way repeated ANOVA),significant level as p < 0.05 in the statistical method.Result: 1.Gait parameters and walking functionIn terms of spatiotemporal parameter: The walking speed of GAT group and the routine group was significantly higher than that before the training(P<0.05).Step width has the interaction between groups and time.After 4 weeks of training,the step width of the GAT group decreased significantly compared with that before the training(P<0.05),while the step width of the conventional group did not change significantly(P>0.05).After 4 weeks of training,the step length symmetry ratio(P<0.05),swing time symmetry ratio(P<0.05)and support time symmetry ratio(P<0.05)of the GAT group were more significantly reduced than those of the conventional group,with significant differences.In terms of kinematic parameters: After training,the maximum hip flexion angle and maximum knee flexion angle of the GAT group and the conventional group did not change significantly(P>0.05).The maximum hip abduction angle in the GAT group decreased significantly after training(P<0.05),which was statistically significant,while there was no significant change in the conventional group after training(P>0.05).After 4 weeks of training,the maximal ankle plantar flexion angle and the maximal foot varus angle in both groups decreased compared with that before training(P<0.05).In terms of kinetic parameters: A-GRF showed the interaction between the group and time.After 4 weeks of walking training,the component of the forward ground reaction force in the GAT group was significantly increased(P<0.05),while there was no statistical difference in the changes before and after training in the control group(P>0.05).In terms of clinical walking function: After 4 weeks of training,the duration of TUG test in both groups was significantly reduced(P<0.05),which was statistically significant.2.Balance function and self-efficacyIn terms of Balance function: After 4 weeks of walking training,Berg scores in both groups increased significantly compared with before training(P<0.05).In terms of self-efficacy: There was an interaction between groups and time.After 4 weeks of walking training,the ABC score of GAT group was more significantly improved than that of the conventional group,with a statistical difference(P<0.05).3.Success rate of gait adaptation tasksAfter 4 weeks of training,the success rate of gait adaptive task was improved in both groups(P<0.05),and the improvement of GAT group was more significant than that of the conventional group(P<0.05).Conclusion: 1.Four-week C-mill gait adaptive training improved walking speed,stride width and symmetry index of stroke patients,and improved clinical walking function.The maximum hip abduction angle,the maximum ankle plantar flexion angle and the maximum foot pronation angle of the affected side were reduced,and the abnormal gait pattern was corrected to some extent.The forward component of the lower extremity reaction force of the affected side increased significantly,which improved the overall walking performance.2.Four-week c-mill gait adaptability training improved the balance function of stroke patients,balanced self-efficacy and the adaptability of walking,improved the overall postural stability,and improved the confidence to complete daily life activities 3.C-Mill gait adaptability training is better than the conventional walking training,is a safe and effective training method,which is worthy of further clinical promotion.